A Patient-centered, System-based Approach to Improve Informed Dialysis Choice and Outcomes in Veterans with CKD
以患者为中心、基于系统的方法,改善 CKD 退伍军人的知情透析选择和结果
基本信息
- 批准号:10607987
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-03-01 至 2025-09-30
- 项目状态:未结题
- 来源:
- 关键词:18 year oldAddressAdvocateArkansasAwarenessBlood VesselsCanadaCaringChronic CareChronic Kidney FailureClinicalClinical ServicesConsentCost of IllnessDataDecision MakingDiagnosisDialysis procedureDiseaseDisease OutcomeEducationEducational ModelsEffectivenessEnd stage renal failureEnrollmentEuropeEuropeanFeesFloridaGlomerular Filtration RateGoalsHealth Care CostsHealth PromotionHealth ServicesHealth Services AccessibilityHealth systemHealthcareHealthcare SystemsHomeImprove AccessInpatientsInterventionInterviewKidneyKidney DiseasesKnowledgeLearningLogistic RegressionsManaged CareMethodsModalityModelingOutcomeOutpatientsOutsourcingPatient EducationPatient Outcomes AssessmentsPatient-Centered CarePatientsPersonsPilot ProjectsPolicy MakerPreparationProtocols documentationRandom AllocationRegression AnalysisReportingResearch PriorityRisk AdjustmentServicesSocietiesStructureSystemTelemedicineTimeUniversitiesVeteransVisitcare burdencare costscohortcostempowermentevidence basehealth related quality of lifehealth service useimprovedmeetingsmortalitypatient orientedpilot testpost interventionpreferenceprimary outcomeprogramsprospectiverural areasatisfactionsecondary outcometreatment as usualurban area
项目摘要
Background: CKD is the 4th most common diagnosis among Veterans. Each year 13,000 Veterans transition
to ESRD. VHA supports over 52,000 ESRD Veterans on dialysis. The care of CKD costs VHA over $18 billion
dollars annually. Transition care of these Veterans is uncoordinated and suboptimal as most receive their pre-
ESRD care within VHA but over 90% are outsourced for their dialysis, on fee-basis. Thus, the majority of
Veterans progressing to ESRD have limited awareness of CKD and its management options including the
dialysis modalities. This leads to gross underuse (7%) of home dialysis (HoD). Professional renal societies and
VHA national CKD program advocate informed dialysis choice, and greater use of HoD for all patients
transitioning to ESRD. European and Canadian reports show that CPE empowers informed choice of dialysis,
increases HoD use, and improves the quality of CKD care. However, availability of CPE within VHA is limited
and HoD utilization is low. To address these issues, we have developed and pilot-tested a concise CPE model
in two different universities and affiliated VA in Florida and Arkansas. Our preliminary findings show that CPE
improves patient informed dialysis choice, and increases HoD selection to 74% and HoD use to 61%. In a
separate pilot study, we found that tele-CPE is as efficacious as F2F-CPE. Objectives: The overall goal of this
RCT is to investigate the impact of CPE on patient knowledge and confidence, HoD selection and use, and
patient-reported, health services and clinical outcomes in a cohort of Veterans who were diagnosed with CKD
and receive CKD treatment from the North Florida/South Georgia Veterans Health System (NF/SG VHS). The
study aligns with HSR&D major research priorities including “patient-centered care, care management, and
health promotion” and “health care systems change.” The 4 Specific Aims are: Aim 1: Compare the impact of
CPE on Veterans’ knowledge of CKD, their confidence in dialysis decision making, and their selection of
dialysis modality, between the CPE and usual care groups. Aim 2: Compare Veterans’ actual use of HoD
(Primary Outcome) between the CPE and usual care groups. Aim 3: Examine Veterans’ perceived satisfaction
with CPE, explore their preferences for F2F- or Tele-CPE, and investigate barriers and facilitators in the
selection and use of their preferred dialysis modality. (Qualitative) Aim 4: Compare the following post-ESRD
secondary outcomes between the CPE and usual care groups. Patient reported outcomes: 1) health-related
quality of life and 2) satisfaction with dialysis; clinical outcomes: 3) time to ESRD, 4) estimated glomerular
filtration rate at ESRD, 5) need for inpatient initiation of dialysis, and 6) vascular access status at ESRD; and
health services utilization outcomes: 7) number of inpatient stays, and 8) number of outpatient visits, from
enrollment to 90-day post ESRD period. Methods: In this mixed method RCT, we will enroll 800 Veterans with
stage 4 or 5 CKD, ≥18 years of age, English speaking, and not yet on dialysis who receive CKD care from
NF/SG VHS. In 1:1 ratio, all the consented Veterans will be randomly allocated into intervention (CPE) or
control (enhanced usual care or EUC) group. For Aim 1, multiple regression analysis will be applied to model
the risk-adjusted post-intervention CKD knowledge and confidence in Veteran dialysis decision making; For
Aim 2, logistic regression will be used to compare the HoD selection and use between the CPE and EUC
groups. Aim 3 will be a qualitative study using semi-structured interviews to obtain in-depth data on Veterans’
satisfaction with CPE, preference for CPE delivery, and barriers and facilitators to HoD selection and use as a
dialysis. For Aim 4, multiple regression analysis will be applied to model the risk-adjusted effects of CPE, HoD,
and the group-modality interaction on outcomes. Expected Results: We anticipate that CPE will enhance
Veterans’ CKD knowledge and confidence for informed dialysis selection, and increase HoD use, leading to
improved Veterans’ and health services outcomes. Next Step: If successful, this study may deliver a ready to
roll-out strategy to meet the CKD care needs of the Veterans and reduce VHA healthcare costs.
背景:CKD是退伍军人中第四大常见诊断。每年有13000名退伍军人过渡
项目成果
期刊论文数量(1)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Encapsulated Peritoneal Sclerosis Masquerading as an Abdominal Catastrophe in Peritoneal Dialysis Therapy.
- DOI:10.7759/cureus.12934
- 发表时间:2021-01-27
- 期刊:
- 影响因子:0
- 作者:Leeoloy J;Kambojia M;Wagle Shukla A;Liu X;Shukla A
- 通讯作者:Shukla A
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{{ truncateString('Huanguang Jia', 18)}}的其他基金
A Patient-centered, System-based Approach to Improve Informed Dialysis Choice and Outcomes in Veterans with CKD
以患者为中心、基于系统的方法,改善 CKD 退伍军人的知情透析选择和结果
- 批准号:
10376724 - 财政年份:2020
- 资助金额:
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